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Forms

NII forms for submitting a claim for benefit and for matters of insurance and collection of insurance contributions.

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  General
  Accident Contributions
  Maintenance payments
  Bankruptcy
  Children
  Domestic Violence
  Employers
  General Disability
  Income Support
  Injury Allowance
  Insurance and Collection
  Long-Term Care
  Maternity
  Mobility
  Old Age and Survivors
  Prisoners of Zion and Families of Martyrs
  Rehabilitation
  Required Work Grant
  Reserve Service
  Unemployment
  Victims of Hostilities
  Work Disability and Dependants

FormOrderDownload
16 - Request of a Public Entity for InformationClick for details
הזמנהDownload
17 - Waiver for Insurance CompaniesClick for details
הזמנהDownload
18 - Waiver of Medical Confidentiality and Authorization to Provide InformationClick for details
הזמנהDownload
20 - Request for Equity GrantClick for details
 Download
851 - Request for InformationClick for details
 Download
900 - Notification of Personal Detail UpdateClick for details
הזמנהDownload
8015 - Request for an Available Position as a Civil ServantClick for details
 Download

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FormOrderDownload
2201 - Claim for Accident Injury AllowanceClick for details
הזמנהDownload

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FormOrderDownload
5400 - Payment Under the Maintenance LawClick for details
הזמנהDownload
5409 – Declaration under the Maintenance (Alimony) LawClick for details
 Download
5422 – Request to cease/renew maintenance paymentsClick for details
 Download
5024 – Claim for study grant for divorced womanClick for details
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FormOrderDownload
5305 - Payment Claim for Salary Debt and Termination CompensationClick for details
הזמנהDownload
5310 - Payment Claim for Debt to Provident FundClick for details
הזמנהDownload

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FormOrderDownload
5015 - Study GrantClick for details
 Download
5020 - File Split RequestClick for details
 Download
5025 - Personal Claim Form for Child AllowanceClick for details
 Download
5026 - Request to Change Payment Location, Address, Allowance RecipientClick for details
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FormOrderDownload
235 - Compensation Claim Under the Compensation LawClick for details
הזמנהDownload

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FormOrderDownload
103 - Employee CardClick for details
 Download
614 - Housekeeper Employment NotificationClick for details
 Download
619 – Exemption from payment of national and health insurance contributions on pensionClick for details
 Download
620 – worker's declaration regarding who is his primary employerClick for details
 Download
622 – Report of kibbutz or collective settlement on membersClick for details
 Download
623 – Report on change in types of kibbutz workersClick for details
 Download
644 – Declaration of person working for a secondary employerClick for details
 Download
648 - Subcontractor NotificationClick for details
 Download
649 – Report on employment of workers during election periodClick for details
 Download
652 – Report for insured classified as salaried employees under National Insurance orderClick for details
 Download
659 - Refund Application for Insurance Contribution and/or Health Insurance ContributionClick for details
 Download
699 – Employer's announcement of file closingClick for details
 Download
752 - Application for Insurance Contribution RefundClick for details
הזמנהDownload
753 - Application for Insurance Contribution CoordinationClick for details
הזמנהDownload
754 – Request for cancelation/reductionClick for details
 Download
100 - Annual breakdown of wages and deductions of worker's national and health insurance contributionsClick for details
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FormOrderDownload
7801 - Claim for Disability Pension and Statement for Insurance and Collections DepartmentClick for details
 Download
7821 - Claim for Benefit for Disabled ChildClick for details
 Download
7849 - Attendance Allowance for Those Not Receiving Disability PensionClick for details
 Download
7850 - Attendance Allowance Claim for Those Receiving Disability Pension/Claim for Attendance Allowance for ImmigrantsClick for details
 Download
7870 - claim for compensation under Polio Victims Compensation Law-2007Click for details
 Download
3209 - Statement of Employment and Income of Disabled Person and SpouseClick for details
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FormOrderDownload
5608 – general questionnaire to examine assetsClick for details
 Download
5619 - Self-Filling Form - Claim for Income Support BenefitClick for details
הזמנהDownload

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FormOrderDownload
211 - Claim for Injury Allowance and Notification of Work InjuryClick for details
הזמנהDownload
250 - Form for Providing Medical Treatment for a Work InjuryClick for details
 Download
283 - Authorization to Provide Medical Care to a Self-employed Person Injured at WorkClick for details
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FormOrderDownload
68 - Adding/Deleting UsersClick for details
 Download
69 - Canceling RepresentationClick for details
 Download
70 - Power of Attorney for RepresentativeClick for details
 Download
107 – Questionnaire for common-law spousesClick for details
 Download
612 – List of volunteers who lived in the country in the month of _____Click for details
 Download
625 – Questionnaire for determining residency – for those with temporary residence visaClick for details
 Download
628 - Questionnaire for Determining Residency of Persons Returning From AbroadClick for details
 Download
630 - Request to Join the Client Representation SystemClick for details
 Download
631 - Request for deposition of Joint PropertyClick for details
 Download
672 - Request to Correct Tax AdvancesClick for details
 Download
1050 – Registration questionnaireClick for details
 Download
6101 - Multi-Annual ReportClick for details
הזמנהDownload
6102 – Detailed annual reportClick for details
 Download
6124 – Order to debit an account by means of credit cardClick for details
 Download
6127 - Direct Debit Order Authorization FormClick for details
הזמנהDownload
6130 - Request for Credit RefundClick for details
 Download
6131 – Declaration of occupationsClick for details
 Download
6134 - Request for Cancellation/Reduction of Fines and LinkageClick for details
 Download
6978 - Direct Debit Order and Standing Order AgreementClick for details
 Download
627 - Questionnaire for determining residency of persons living abroadClick for details
 Download

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FormOrderDownload
2600 - Claim for Long-term Care BenefitClick for details
הזמנהDownload
2620 - Request to Re-Examine an Eligible Person Due to the Claim of DeteriorationClick for details
הזמנהDownload

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FormOrderDownload
300 - Maternity Allowance and Hospitalization Payment ClaimClick for details
הזמנהDownload
330 - Risk Pregnancy Benefit Payment ClaimClick for details
 Download
331 - Medical Authorization for the Risk Pregnancy AllowanceClick for details
 Download
355 - Claim for Maternity Allowance or Vacation Pay for Adopting MotherClick for details
הזמנהDownload
368 - Claim to Extend or Split Maternity Grant/Maternity Leave Grant for an Adopting MotherClick for details
 Download
360 – Claim for maternity allowance for a father entitled to maternity leaveClick for details
 Download

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FormOrderDownload
8200 - Claim for Benefits Under the Mobility AgreementClick for details
 Download
8220 - Application for Medical Examination to Determine Mobility DisabilityClick for details
 Download

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FormOrderDownload
410 - Claim for Survivor’s PensionClick for details
הזמנהDownload
416 - Claim for Grant or Pension Balance for SurvivorsClick for details
הזמנהDownload
420 - Life CertificateClick for details
 Download
430 - Income Supplement Claim for Recipient of Old Age or Survivor’s PensionClick for details
 Download
480 - Old-Age PensionClick for details
הזמנהDownload
484 - Claim for a Dependent's Increment to Old-Age PensionClick for details
 Download
487 - Claim for Survivors' Pension(English)Click for details
 Download
488 - Claim for Old-Age Pension -International convention (English)Click for details
 Download
2910 - Claim for Maintenance Allowance for OrphansClick for details
הזמנהDownload
3296 - Claim for Additional Payment for Dependants to SpouseClick for details
הזמנהDownload
460 תביעה אישית לדמי קבורהClick for details
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FormOrderDownload
5900 - A request to recognize/grant benefit to the family of a Prisoner of ZionClick for details
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FormOrderDownload
Claim for Special Grant to Work Disabled - 266Click for details
 Download
270 - Vocational Rehabilitation ClaimClick for details
 Download
271 - Application for an Advance/Loan/Conditioned GrantClick for details
 Download
Application for an Pension Conversion - 3255Click for details
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FormOrderDownload
1521 - Payment Claim for the GrantClick for details
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FormOrderDownload
Employer Claim for Refund of Reservist’s Benefit - 501Click for details
 Download
Personal Claim for Reservist’s Benefit - 502Click for details
 Download
509 - request form for payment on account of reservist's benefitClick for details
 Download
510 - Employer Confirmation of Employment and SalaryClick for details
 Download

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FormOrderDownload
1500 - Claim for Unemployment BenefitClick for details
הזמנהDownload
1514 - Employer Authorization of Employment Period and PayClick for details
 Download
1517 – Claim for grant to unemployed person working at low wagesClick for details
 Download

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FormOrderDownload
580 - Notification of Injury in a Hostile Act and Claim for Medical Treatment BenefitClick for details
הזמנהDownload
581 - Application to Determine Degree of Disability and Payment of Disability PensionClick for details
 Download
582 - Claim for Compensation for the Families of Those Killed in Terrorist Acts(Hebrew)Click for details
 Download
584 - Compensation Claim for the Families of Those Killed in Terrorist Acts(English)Click for details
 Download
Notification of Injury in a Terrorist Act and Claim for Medical Compensation (English) - 597Click for details
 Download
587 - Application for a Participating School Grant for Terrorist Act Disabled ChildrenClick for details
 Download

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FormOrderDownload
200 - Claim to Determine Degree of Disability from WorkClick for details
הזמנהDownload
210 - Claim for Combining Work Disability DegreesClick for details
הזמנהDownload
213 - Claim of Allowance to Dependants of Work InjuredClick for details
הזמנהDownload
215 - Claim to Schedule a New Hearing of the Disability Degree Due to Income DropClick for details
הזמנהDownload
228 - Reprocessing Claim (Deterioration of Condition)Click for details
הזמנהDownload
Claim for Maintenance Allowance for a Child - 230Click for details
הזמנהDownload
759 - Leaflet for Those Summoned Before Medical Committees - Work DisabilityClick for details
הזמנהDownload
279 - Claim for a Disabled Person in NeedClick for details
הזמנהDownload

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